Healthcare Update — 06-13-2011

Visitors gone wild. Gang of people tried to push their way into the emergency department at Nassau University Medical Center and were threatening hospital staff in the process. Police were called and fight breaks out. Police officer breaks hand. Eleven people were arrested.

An average of 640 people each day are treated in the emergency department each day for nonfatal injuries that occur in the bathroom. In other news, as a result of this study, JCAHO has now declared bathrooms a public health threat. In the name of patient safety, JCAHO will now require that all hospitals install outhouses in their parking lots.

Medicaid jumps on the “never event” bandwagon. There are some errors that shouldn’t be compensated. Other errors on Medicaid’s list are unpreventable. Remember the discussion about obstetricians refusing to treat obese patients? When governments refuse to pay for some events that are unpreventable, it just gives providers another reason not to treat patients at risk for those events.

Patient’s estate sues physician and hospital after surgeon accidentally nicks bowel during hernia surgery, patient returns to emergency department a few days later, the injury is found during exploratory surgery five days after initial surgery, and then patient dies more than 8 months later. OR nurses are dismissed from the complaint, but other defendants continue to defend the suit.

When hospitals are so busy that they can’t take ambulance runs (known as “being on diversion”), patients have a greater chance of dying from heart attacks. Study shows that patients with heart attacks were more likely to die when their closest hospital was on diversion for more than 12 hours during the day they suffered their heart attack. Interesting that there was no difference in mortality between hospitals that were on no diversion and those that were on diversion for less than 12 hours. The researchers noted that “It is important to emphasize that while demand on emergency care is increasing…, supply of emergency care is decreasing. If these issues are not addressed on a larger scale, ED conditions will deteriorate, having significant implications for all.” I would probably change that last sentence to “will continue to deteriorate.” As more emergency departments close and as emergency department utilization will soon increase significantly, we’re getting very close to a tipping point.

Fear of litigation hurts doctors and can hurt access to care. This article shows that an average neurosurgeon in Cook County, IL pays $4,500 per week in malpractice insurance and internists pay about $730/week. Specialists in outlying counties who pay high prices for malpractice insurance but who see fewer patients may not be able to sustain a practice – which reduces available care in rural counties.

Mass. resident here, who needs access to health care on a regular basis (internist 2-3x/yr, cardiologist 2x/yr, gyn/oncologist & retina specialist annually) who currently pays over $8K per year (more than 15% of my income) in premiums for individual insurance with a $1K deductible–and it’s by no means a gold-plated plan. I support the law because without it I would not be able to buy insurance at all, thanks to my history of cancer. I am, however, very concerned at how rapidly my insurance costs are rising; if they don’t put the brakes on, soon I will once again be unable to buy insurance because it will be too expensive–assuming I want to continue living indoors and eating regularly.

There’s a glaring error in the Medical Economics article about “RomneyCare,” which states that “35% of internists and 44% of family physicians accept Commonwealth Choice, a nonsubsidized health insurance program for uninsured adult Massachusetts residents.” There is no insurance called “Commonwealth Choice,” which is why so few doctors accept it. Commonwealth Choice is the program through which individuals like me and small businesses, which are pooled for actuarial purposes, purchase health insurance plans from Harvard Pilgrim Health Care, Blue Cross Blue Shield, and several other insurance companies. Mine, for instance, is HMO Blue, which is what it says on the card. There’s nothing on the card to indicate that I bought it through the Commonwealth Choice program. Therefore, it’s likely that the reason so many doctors don’t accept “Commonwealth Choice” insurance is because it doesn’t exist. Those who said they accept it are probably the minority who are aware that Commonwealth Choice is simply a clearinghouse through which insurance is bought, not an insurance plan itself.

So why should other people be subsidizing you. If your file came up in front of me and I see over a half dozen repeat specialist visits per year and a history of cancer, I’d say you’re not worth the investment.

“So why should other people be subsidizing you. If your file came up in front of me and I see over a half dozen repeat specialist visits per year and a history of cancer, I’d say you’re not worth the investment.”

Because that is the point of insurance?!?, to cross subsidize across different age and risk groups because in the past and for most here in the present this is a social compact that we value… If that is truly ones thought then lets just “death panel” everyone once they reach medicare age and entirely kill that program, palliative care only and that’s it. I suppose we could go even further and do away with any and all “insurance” everyone will pay into their own health savings account and pay for all their healthcare with this fund and any other funds they can scare up, no money no treatment.

I used to be on staff at Kenneth Hall Regional hospital, the one that closed it’s E.D. It’s been years since I was there, and I’m surprised it took this long to close, as it has been losing $5-6M per year. Being the only hospital serving a city of about 40K, you can imagine the volume that came through there. And being the only level 2 on the outskirts of downtown St. Louis, it got more than its share of trauma. Really is too bad that the community, which has lost much of its infrastructure and half of its population in the last 40-50 years, no longer can use the facility for acute care and must go additional 5 miles to get to the nearest hospital.

I never had anybody tell me how a post op hip or knee dvt is a never event. I have not seen a study that reveals that NO DVT’s have never occurred with anticoagulation. The simple fact is they can and do. Just another example of cms making broad decisions that have nothing to do with evidence.

Ok- the drunk man being given haldol, then punched a nurse? And he got away with it?! I wonder what would have happened if he had not been a US vet. I give respect where respect is due, and recognize the sacrifice many service men and women have made. However- that does not give anyone the right to be a drunken fool and act like that, assaulting a nurse, then getting away with it.

Wonder where the rest of the facts are- seems this biased article left out a few key details its readers may not know about care of the drunk and disorderly in an ER setting.

Of course, if that were a clinic, he’d be banned from it. Thank goodness for EMTALA, we get to see these jerks again and again. Sorry for the rant, just sick of the abuse of ER staff across the country.

On the hernia surgery, aren’t waiver papers signed beforehand for things like that? I had a laparoscopic resection a few years ago, and recall some documents of pretty fine text talking about potential negative outcomes that I had to sign.

As a practicing EM physician in Massachusetts Romneycare isn’t the panacea the NYT would like to portray. I’m a well-educated person who has enough difficulty understanding the minutiae of some of these health care plans, so I’m not at all surprised to hear tales of woe from my patients – many who lack an education and/or gainful employment – about how they were dropped from coverage for administrative reasons. Of course we spend a lot of time with financial counselors in the ED to help these poor souls, file the paperwork for them, only to have yet another administrative burden unmet and another rejection by the time of their next visit – usually within a month.

I like the new “never” list especially when it includes all those diabetic issues. Does this mean the noncompliant diabetic who presents with DKA, hypoglycemia, etc. can be billed directly? Thank you Dr. Berwick – another product of academic ivory tower inbreeding.